Acute deep venous thrombosis is a spectrum of disease presentations. Proper treatment mandates precision in diagnosis and knowledge and availability of therapeutic alternatives. Natural history studies and therapeutic trials have indicated that thrombus resolution (elimination) is associated with improved long-term functional outcome. The preferred approach to most patients with proximal venous thrombosis is to eliminate thrombus either pharmacologically or mechanically, to provide unobstructed venous drainage to the affected extremity and to offer subsequent treatment to ensure that recurrent thrombosis does not occur. If these principles can be followed without placing the patient at an unacceptable risk of a complication, substantial strides can be made in the treatment of patients with acute DVT.